You might never see ‘hospital of the future’ firsthand

Hospitals are expected to be very different in 10 years, but because of technology and new approaches to health care, many people are unlikely to see the inside of one.

And most of those who do go for emergency care or surgery aren’t likely to stay long.

“The fact is that if you’re going to be in a hospital, you’re going to be pretty sick,” said Ron Stern, president and CEO of Lovelace Health System, which operates six hospitals, a health plan and a pharmacy system in New Mexico. “As we become more proficient with in-office care, pharmaceuticals and with technology, we will be accelerating the rate at which people can go home.”

Clay Holderman, chief operations officer at Presbyterian Healthcare Services, which runs eight hospitals and a health plan in New Mexico, also expects big changes at hospitals.

But Holderman said they will be driven by a change in payment policies as much as by other factors.

Holderman explained that insurers are beginning to base payments not on how many tests and procedures are being done, but on how effective the care is.

“The focus is changing from volume to value,” Holderman said. “And that’s going to have a profound effect.”

Changes in reimbursement policies and technological advances mean that in the future, the health care system is more likely to center on primary care physicians than hospitals, Holderman said.

Stern said many of those changes are already in effect.

“The future’s here now,” he said. “Doctors can monitor the breathing of a woman in labor while she’s home, and if you have a heart attack, the crew on the ambulance can do an EKG test and send it to the hospital over the phone.”

Advances in areas such as laparoscopic surgery also mean patients are able to go home sooner, because smaller incisions heal faster, Stern said.

Robotic surgery is another innovation that will play an increasing role in hospitals.

Technology, however, isn’t cheap. Stern said Lovelace has invested about $500 million in recent years to upgrade its hospitals. (For a look at how the VA hospital is upgrading its technology, see sidebar, page 12.)

Holderman said Presbyterian spent $200 million this year on an integrated health care record system, more than the $165 million it spent to build its new Rust Medical Center in Rio Rancho.

“This is the first year technology costs passed our other types of costs,” Holderman said.

Presbyterian’s record system reflects another facet of hospitals’ future. Someone arriving at a hospital will soon be greeted by doctors who will have a complete medical history in hand — which other specialists can consult and discuss, probably via computer or smartphone.

“There may come a time when your medical records are even on a chip that’s embedded inside you,” Stern said. “The cost of the technology is tremendous, but the return will be in a decreased utilization of hospitals.”

Stern said rather than bringing more people to hospitals, the Affordable Care Act is likely to save money by having people go to a doctor’s office for basic care instead of an emergency room.

“The emergency room is the most expensive place to come for care, and we spend $70 million a year in charity care,” Stern said. “When those people are insured, the issue will be making sure there are enough primary care physicians to care for them.”

The push for more integrated care — diagnosing and treating conditions before they become critical — and increased reliance on primary care doctors might be beneficial in some areas, but could cause problems in New Mexico’s rural regions, said Jeff Dye, president of the New Mexico Hospital Association.

“Rural facilities will face real challenges, because they will have to deal with more payments being bundled [affecting cash flow] and the only way they can draw physicians to the area is to hire them,” Dye said. “In rural areas, hospitals are the primary care centers.”

Holderman said although many routine hospital stays won’t need to be long, when a patient can leave will depend on what services are available at their home.

“We’ve got to make sure nurses, aides and the necessary monitors and other equipment are available,” Holderman said.

And the public needs to learn that long hospital stays aren’t always going to be necessary.

“When someone comes in and is treated for a heart attack, we have to make sure the family realizes that it’s good news if he or she can go home tomorrow and not think that we’re kicking them out tomorrow,” Holderman said.

But despite all the changes, hospitals will continue to be needed.

“With an aging population, there’s going to be a lot of hips and knees being replaced,” Stern said.